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Introduction

Abnormal uterine bleeding is a common problem encountered in general practice. Heavy menstrual bleeding is the commonest cause of iron-deficiency anaemia in the Western world. A classification of abnormal uterine bleeding is presented in Table 102.1.

Defining what is normal and what is abnormal

This feature is based on a meticulous history, an understanding of the physiology and physiopathology of the menstrual cycle and a clear understanding of what is normal. Most girls reach menarche by the age of 13 (range 10–16 years).1 Dysfunctional bleeding is common in the first 2–3 years after menarche due to many anovulatory cycles resulting in irregular periods, heavy menses and probably dysmenorrhoea.

Once ovulation and regular menstruation are established the cycle usually follows a predictable pattern and any deviation can be considered as abnormal uterine bleeding (see Table 102.2). It is abnormal if the cycle is less than 21 days, the duration of loss is more than 7 days, or the volume of loss is such that menstrual pads of adequate absorbency cannot cope with the flow or clots.4